Provider Demographics
NPI:1649306051
Name:SMITH, SHARON MARIE (LAC)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MR
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:5030 ROUND TOWER PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1322
Mailing Address - Country:US
Mailing Address - Phone:410-997-7040
Mailing Address - Fax:410-997-7040
Practice Address - Street 1:10716 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3106
Practice Address - Country:US
Practice Address - Phone:410-997-7040
Practice Address - Fax:410-997-7040
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist